Question of the Week # 428

428) A 32-year-old male boxer presents to the emergency room after sustaining an injury during a local boxing match.  He was punched by the opponent over his right ear about six hours ago . He complains of pain and swelling over his right ear. He has no hearing deficit or tinnitus or headaches or blurred vision. He denies nausea or vomiting. Past medical history is unremarkable. On examination, his vitals are stable. His right ear is red, warm and swollen with a medium sized anterior auricular swelling which is tender to palpation. There is no facial swelling. If untreated, which of the following would be most likely course of this injury?

A) Spontaneous Resolution

B) Hearing Deficit

C) Permanent ear disfigurement

D) Otitis Externa

E) Mastoiditis

Question of the Week # 427

427) A 32-year-old male boxer presents to the emergency room after sustaining an injury during a local boxing match.  He was punched by the opponent over his right ear about six hours ago . He complains of pain and swelling over his right ear. He has no hearing deficit or tinnitus or headaches or blurred vision. He denies nausea or vomiting. Past medical history is unremarkable. On examination, his vitals are stable. His right ear is red, warm and swollen with a medium sized anterior auricular swelling which is tender to palpation. There is no facial swelling. Which of the following is the most appropriate management?

A) Compressive dressing

B) Needle aspiration of the Hematoma

C) Cold compresses, analgesics and antibiotics

D) Incision and Drainage

E) Observe and await  spontaneous hematoma resolution

Question of the Week # 332

332) A 22 year old ballet dancer is evaluated in your office during a routine annual physical examination. She does not have any complaints except for excessive fear of gaining weight. She reports that her mother thinks she has lost a lot of weight in the past two years however, she personally believes she is excessively fat and seeks help to lose more weight. Her menstrual cycles are irregular occurring, once every three to four months. On examination, she is very thin and has a dry, scaly skin. Her Body Mass Index is 15.0. She is afebrile, heart rate is 54/min and blood pressure 86/54 mm Hg. Complete blood count shows mild anemia. Urine pregnancy test is negative. Which of the following findings are consistent with her diagnosis?

A) Metabolic Acidosis

B) Parotid swelling

C) Hyperkalemia

D) Low serum cortisol

E) Increased Pulmonary vital capacity

Question of the Week # 331

331) A 16 year old girl is evaluated in the office for mild to moderate pain in her left ankle.  She reports that she heard a pop sound followed by the pain when she was about to walk briskly on her way to college. She is unable to walk normally and cannot lift up on to her toes while weight bearing. Her past medical history is significant for recurrent episodes of urinary tract infections. On examination, she is afebrile. There is no bruising or swelling in her left foot. There is tenderness at the back of her left foot about 2 cm above the posterior calcaneus.  Squeezing of the left calf muscle fails to result in passive plantar flexion at the ankle.  Which of the following element if obtained from the patient’s history would help in determining the cause of her presentation?

A) Eating habits

B) Menstrual History

C) Sexual History

D) Recent antibiotic use

E) Family history of Muscular Dystrophy

Question of the Week # 327

327) A 16 year old boy presents to your office for a Pre-participation sports physical examination. He is healthy and physically active and has no complaints. He has no chest pain or shortness of breath. He denies any drug use or smoking. His maternal grandfather recently died suddenly of cardiac arrest from severe Myocardial Infarction at age 82. On physical examination, he is afebrile, pulse 82/min, Respiratory rate 18/min and blood pressure 106/76 mm Hg. Chest is clear to auscultation. Cardiac examination reveals a mid-systolic murmur, grade 2/6 heard best along the left sternal border. The murmur decreases in intensity when he stands and increases when he is supine. S1 and S2 are normal. The second heart sound is physiologically split.  Cardiac impulse and carotid pulses are normal. The most appropriate action at this time:

A) Clear the patient for Sports participation

B) Refer to cardiology

C) Obtain 2D-Echocardiogram

D) Schedule Exercise Stress Test

E) Obtain Complete blood count

Question of the week # 289

289) A 32 year old male athlete is evaluated in the office for bilateral breast enlargement. He is a state champion in running and is scheduled to participate in the national level running championship in few weeks. He is very concerned about his appearance.   He denies using any illicit drugs or exogenous androgens or aromatase inhibitors  is seen in the office during a routine follow up visit.  His past medical history is unremarkable. Physical examination reveals gynecomastia bilaterally. His laboratory investigations reveal:

WBC 8.8k/µl

Hemoglobin 18.5 g/dL ( Normal = 13.0 to 16.5 gm%),

Mean cell volume (MCV)  84  fL

Platelet count 310k/µl

Which of the following is most useful in establishing the diagnosis?

A) Erythropoetin level

B) Urine Drug Screen

C) Serum Total Testosterone

D) Urine Testosterone/ Epitestosterone ratio

E) Serum Free Testosterone

Question of the Week # 204

204) A 16 year old boy presents for pre-participation examination prior to athletic training in his college campus. He denies any history of dizziness or palpitations or shortness of breath upon exertion. He denies any syncopal episodes.  His father died of cardiac arrest during a marathon at the age of 32 years. Physical examination reveals a systolic murmur that increases with valsalva maneuver.  Electrocardiogram reveals changes consistent with left ventricular hypertrophy. An echocardiogram reveals asymmetric septal hypertrophy and Systolic Anterior Motion (SAM) of the Anterior Mitral Leaflet. Which of the following is an indication for Implantable Cardioverter-Defibrillator in this patient?

A) Left Ventricular Thickness of 22mm

B) Increase in blood pressure upon exercise

C) His age

D) Systolic Anterior Motion of Mitral leaflet

E) Decrease in blood pressure during exercise

 

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